Provider Demographics
NPI:1265451728
Name:ALTMAN, LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6926
Mailing Address - Country:US
Mailing Address - Phone:201-585-5180
Mailing Address - Fax:201-585-0347
Practice Address - Street 1:1644 PARKER AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6926
Practice Address - Country:US
Practice Address - Phone:201-585-5180
Practice Address - Fax:201-585-0347
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ567898Medicare PIN